Today is National Walk At Lunch Day. Blue Cross Blue Shield started National Walk At Lunch Day four years ago to encourage office workers to get up and get moving. All over the country, people are lacing up their sneakers and heading out of the office at lunch. Walking is a great, low-impact exercise. Taking a 30 minute walk 5 days a week has been shown to lower the risk of hypertension and type 2 diabetes, and improve joint and bone health.

Being sedentary is one of the worst things people can do for their health. Studies have shown that regardless of how much exercise people get, prolonged sitting increases their risk of death by 40%! Prolonged sitting disrupts the body's metabolic functions, leading to poor vascular health.

As physical therapists, there is likely more physical activity built into your average workday than most of your patients. But you shouldn't take that for granted. When fellow blogger Lisa switched to a smaller facility, she remarked on she didn't have nearly as much built-in walking time during her shifts. She's making a conscious effort to move more during the day.

And that's what National Walk At Lunch Day is all about. Being active every day matters. Encourage your patients to get out there, even for fifteen minutes. Little things can make a big difference when it comes to health.

As the 2012 Olympic Games draw near in London, England, excitement is building across the United States and around the world. The caliber of athletes who qualify and train for the Olympics is beyond comprehension. Due to a rigorous training schedule, often 8 to 10 hours a day, 7 days per week, the strain on their bodies-not to mention the potential risk of injury-is incalculable.

Do you dream of being a PT for Olympic athletes and maybe even becoming a member of an Olympic Games sports medicine staff?

If so, here's your chance to get in on the action. The United States Olympic Committee (USOC) is in need of volunteers to help keep U.S. athletes healthy and ready for their next competition.

From torn ligaments to recovering from knee surgery, the hard working athletes are susceptible to it all. Each of the three U.S. Olympic Training Centers (OTC) houses an experienced multidisciplinary sports medicine staff responsible for the delivery of health care to athletes participating in its programs.

The team, including physical therapists, athletic trainers and chiropractors, provides care for the athletes 24/7 at the OTCs located in Colorado Springs, CO, Lake Placid, NY, and Chula Vista, CA. Care includes a collaborative approach to prevention, evaluation, management, treatment and rehabilitation of athletic injuries and illnesses for U.S. Olympians and Paralympians.

During the clinics' busier periods, the USOC staff is accompanied by volunteer medical providers participating in the USOC Sports Medicine Volunteer Program.

The two-week volunteer opportunities are available to qualified health care professionals with at least 3 years of experience in working with athletes. USOC Sports Medicine Volunteers include physicians, chiropractors, athletic trainers, physical therapists and massage therapists. The volunteers work side-by-side with the USOC Sports Medicine staff to evaluate and care for Team USA athletes.

"This is a tremendous opportunity to stay on campus and work to help make athletes better," relayed Heather Linden, DPT, health care provider, sports medicine division of the United States Olympic Committee. "I began as a volunteer and it's a true honor to learn from all the practitioners and now work with Team USA's elite athletes full-time."

The USOC is looking for highly qualified, team oriented individuals to help year-round at each of its three clinics. The USOC provides ground transportation and room and board for accepted volunteer applicants.

If interested, please contact Jenna Street, MS, ATC, coordinator of sports medicine clinic operations at jenna.street@usoc.org or (719) 866-2548 or visit http://www.teamusa.org/medical/volunteers for volunteer applications.

Check back for our June 11 cover story which will present a behind-the-scenes look at a few physical therapists and an athletic trainer working at the facility in Colorado Springs, CO, as they prepare to travel to London for the Summer Olympic Games.

In a battle of college basketball royalty last night, the University of Kentucky emerged as the 2012 NCAA Men's Champion with a hard-fought, 67-59 victory over the University of Kansas. The teams also rank first and second, respectively, on the list of all-time winningest college basketball programs. To coincide with the end of another exciting season, ADVANCE published its cover story this week, "Hard to the Hoop," about the role that rehab professionals play in Division I basketball.

Athletic trainers and physical therapists work in collaboration to both prevent player injuries and rehabilitate those injuries that do occur. It is a fast-paced, exciting and challenging setting, where the pressure is on to perform while thousands of students, staff, alumni and fans keep watch. Have you ever treated basketball players? What did you find most rewarding or difficult about it? What is your opinion about the dynamics of the athletic trainer-physical therapist relationship in trying to produce the best possible outcomes?

Recently, we posted this list of the top physical therapy schools, as selected by US News and World Report. The magazine ranked the schools based on surveys sent to deans and other high ranking university officials. The sole criteria was "the academic quality of a program."

Given the vast number of physical therapy programs out there, chances are most PTs did not graduate from one of the top ten. But does that matter? It's interesting that the list was purely focused on academics and did not include student or alumni input. As anyone who's gone to college can tell you, academic excellence is just one piece of the pie. Location, affordability, internship opportunities, retention rates, courses offered, even the visual appeal of a campus all factor into deciding where to spend education dollars. 

Yet there is no one-size-fits-all when it comes to education. The opportunity to study under a renowed professor may matter highly to applicant A while the chance to live and study in a new part of the country may matter highly to applicant B. Physical therapy school is three years of someone's life. Most physical therapists probably weighed the pros and cons of multiple universities before picking the one that's the right fit for them.

What factors did you consider when chosing a PT school? Were you happy with your decision?

It was an unusually warm and sunny March day and with an 11 a.m. start time, the conditions certainly were not ideal. But more than 3300 runners turned out on race day to enjoy the 35^th year of this event.

I generally run about 15-20 miles per week but started training for the half about 5 weeks before race day. If I had to do it again, I would have ramped up my mileage over the course of a few more weeks. Likely due to my hasty training, I began having shin pain about a week ago. Naturally, I was concerned about how the pain would affect me during the race.

I visited Tom Crabbe, MS, DC, CCSP, of Crabbe Chiropractic, in a tent before the race and he tended to my shins. First he applied a topical analgesic and massaged the muscles on my shins. Then he applied therapeutic tape to relieve the muscular pain and inflammation.

Thanks to Dr. Crabbe's work, my shins were not a factor at all during the race. I finished the race in 2:03:08 and was generally pleased with my pace (although I crossed the halfway mark at 00:56:42 and got entirely too excited about the prospect of breaking 2 hours!). The crowds cheering on the sidelines were truly amazing and often brought a huge smile to my face just when I needed a pick me up.

There were many high points of the race but there is one memory that I will hold with me for all of my days. During mile two, I heard cheering ahead of us and as I got closer, I realized we were passing Team Hoyt. I nearly broke down in tears when I saw this father-son duo that has participated in more than 1,000 races together. After their first race in 1977, Rick-who was diagnosed as a spastic quadriplegic with cerebral palsy-told his father, "Dad, when I'm running, it feels like I'm not handicapped."

But when it comes to manual therapy, it might be time to reconsider this complicated physiological and psychological mechanism.

"Placebo is not the same as doing nothing," said Joel Bialosky, PT, PhD, OCS, FAAOMPT, clinical assistant professor at the University of Florida, during his presentation "Manual Therapy: How Does it Work?" at CSM 2012 in Chicago. "It's a physiological and psychological response that involves conditioning and expectation."

"Manual therapy and placebo might work through similar mechanisms," said Dr. Bialosky, who co-presented the session with Joshua Cleland, PT, DPT, PhD, OCS, FAAOMPT, physical therapy professor at Franklin Pierce University in New Hampshire. The effectiveness of manual therapy may arise as much through "nonspecific effects" -- such as the patient-clinician interaction and whether patients expect the intervention to help -- then through orthopedic and biomechanical avenues such as increasing mobility or removing tissue adhesions, he said.

Patient expectation is a large part of placebo's effectiveness. Dr. Bialosky lead-authored a study in the Feb. 2008 issue of the journal BMC Musculoskeletal Disorders that correlated patient expectations to clinical outcomes for spinal manipulation for low-back pain. Randomly assigned patients were told to expect either positive, negative or neutral results from manipulation. Those with "good expectations" and "bad expectations" experienced positive and negative clinical results respectively. The most positive results were witnessed in the neutral expectation group.

"Clearly, expectation may play a role in the clinical outcomes we see in our patients," said Dr. Bialosky.

He went on to use the illustration of World War II soldiers storming the beaches of Normandy to convey the message that pain is a sensory and emotional experience that changes with context and perceived threat. Many of these soldiers sustained catastrophic injuries during maneuvers, but continued to run pain-free until they reached a safe place, when the pain became unbearable. Childbirth is another example.

"Pain is multidimensional, and context-related," said Dr. Bialosky. "We get focused on the sensory component." Rather than thinking of manipulation and other manual interventions as operating in solo, its effects are multilayered. "We don't know what the magnitude of the placebo response is in manual therapy," he said.

"I'm not advocating that we knowingly give our patients placebo," concluded Dr. Bialosky. "But we can use it to our advantage."

Leverage the power of patient expectation in your clinical decision making process -- ask whether the patient has had this problem before, and what treatments were successful. If an intervention that you know to be evidence-based has not worked for them in the past, take special care to explain the rationale behind it. Reduce anxiety levels, which have a negative effect on placebo responses.

"Placebo is an active agent," said Dr. Bialosky. "Future research and clinicians should embrace -- not avoid -- its effect."

One of them struck me immediately: "What You Wear to Work: Appropriate Attire and Professional Image for Our Doctoring Profession."

This was a cross-section presentation and caught my interest because it broached a subject we at ADVANCE know a lot about. We constantly hear readers' opinions on how PTs and PTAs are presented in our pages and on our website. If a therapist doesn't approve of what the subject is wearing, we are often the first to know--even though we had no control over what any given therapist in a clinic is wearing on the specific day of our photo shoot.

The presenters at the session cited research that resulted from studies on patient perceptions of clinicians who wore certain types of clothing or uniforms while on the job. The panelists had a little fun too, in the form of a "fashion show" of volunteer students who dressed in varying stages of attire, some appropriate for work at a clinic or hospital and some not so appropriate.

As it turns out, other therapists are not the only people to notice what you are wearing and how you present yourself in a clinic. The major point made: Therapists' attire has just as much of an effect on patient perception of therapists' ability as it does on your boss or supervisors' perception. If your new boss doesn't seem to mind your multiple piercings or your tinted-blue hair, fine--but be aware that the patients you treat might find such appearances, well, off-putting. And it doesn't merely come down to their conservative preferences; the research cited by the presenters says your appearance just might be equated to how competent you are as a therapist.

Mostly, the research showed that while patients preferred physicians wearing white lab coats while delivering treatment, patients overall preferred that their therapist in an inpatient setting be wearing scrubs (in a solid color) and a Polo shirt and twill slacks in an outpatient setting. In a companion study, the same results were found for inpatient and outpatient clinic directors respectively. The studies went into other details as well, including what patients saw as least desirable in clinician dress (i.e., too-colorful attire, casual, open shoes, unkempt hair, "play" clothes like shorts), and what was considered "impractical" (i.e., flip-flops or too-high heels, hanging or too-loose clothing, accessories like ties and scarves that could carry germs).

The take-away lesson here: Be mindful of how you dress because it says a lot about you---not just to your supervisor, but also to your patients. Something as simple as choosing the right footwear and covering up your tats can ensure your success in the workplace as you enter your first job.

On Feb. 22, President Obama signed the Middle Class Tax Relief and Job Creation Act of 2012 (HR 3630), noted a Feb. 24 press release from the APTA. Among other facets, this act extends the therapy cap exceptions process for the remainder of 2012. The law mandates consistent use of the KX modifier upon reaching the $1,880 therapy cap and puts in place several reforms to the therapy cap policy.

Starting Oct. 1, claims that meet or exceed $3,700 in annual therapy expenditures will be subject to a manual medical review. The $3,700 threshold will be applied to the combined physical therapy/speech-language pathology cap; a separate $3,700 threshold will be applied to the occupational therapy cap. Also starting Oct. 1, each request for payment must include the national provider identifier of the physician who currently periodically reviews the plan of care. Additionally, HR 3630 designates that the therapy cap, along with the exceptions process, should apply to the hospital outpatient setting no later than Oct. 1. This provision, as well as the full exceptions process, will expire at the end of 2012 unless Congress chooses to extend them into 2013.

What is your reaction to this legislation and its impact on the physical therapy profession?

CHICAGO -- All of us have chance encounters in our histories -- whether it's the person you met on vacation who ended up becoming your spouse, or the random conversation you struck up with a stranger on a plane that led to your dream job.

Don't underestimate the power of these seemingly minor events -- use them to your advantage, stressed Lawrence Cahalin, PT, PhD, CCS, professor of physical therapy at the University of Miami's Miller School of Medicine. Dr. Cahalin summarized his own journey through PT research and academia, in which seemingly small events led to large career transitions, during the APTA's Linda Crane Lecture at the Combined Sections Meeting in Chicago Feb. 9.

Dr. Cahalin's talk was titled "Professionalism and Core Values in Physical Therapy."

Dr. Cahalin began as a business student at the University of Missouri in St. Louis. While visiting the school's career center, he happened to open a book on career choices directly to a page describing physical therapy and the work that PTs do. Dr. Cahalin immediately applied to the school's PT program, and a career was born.

Later, as a PT student at Missouri, Dr. Cahalin was unsure of where to direct his talents when he happened to notice an issue of the Cardiopulmonary Physical Therapy Journal, and in particular an article profiling the cardiopulmonary research program at the University of Southern California. Dr. Cahalin contacted the program and soon found himself conducting research alongside notable cardiovascular physical therapists Scot Irwin, Randy Ice, Ray Blessey and Bob Huhn.

While at USC, Dr. Cahalin's advisor was Helen Hislop, who spent three decades in USC's physical therapy department and has an APTA award named in her honor for outstanding contributions to PT literature. Hislop advised Dr. Cahalin to move to the University of Iowa, where he could further develop his talents, and where he would ultimately earn his master's of physical therapy degree.

Further "chance encounters" would lead Dr. Cahalin to the University of Massachusetts Boston, where he'd earn his PhD in gerontology, and academic positions at Boston University, Northeastern University and now the University of Miami.

"We love the social capital" in physical therapy, Dr. Cahalin told his audience. Chance encounters are abundant in such a people-driven profession. Take charge of these random moments and optimize their power by following up on recommendations, returning phone calls and maximizing your involvement in professional associations. "We can't just leave things up to chance," he said.

From the recent lawsuits brought by former players against the NFL to the death last year of hockey enforcer Derek Boogaard, mild traumatic brain injuries have been in the news a lot lately. Yet sports is not the only arena where concussions are a risk. In the CSM presentation "Military Initiatives to Provide Guidance for Assessment/Intervention of Individuals with Concussion/Mild Traumatic Brain Injury," Maggie Weightman, PT, PhD and Karen McCulloch, PT, PhD, NCS talked about how soldiers are rehabilitated following battlefield related TBI. "There's a difference between a concussion occurring in a military setting and on a hockey rink," said Dr. Weightman. The two speakers are fellows in the Office of The Surgeon General's Rehabilitation and Reintegration Division.  The division provides oversight of rehab process for a variety of wounded warrior injuries, including concussions.

Advanced helmet technology lets soldiers survive injuries that 20 years ago would have been fatal; yet they do not emerge unscathed. In the battlefield, 50% of cases of mild TBI came from blasts. Diagnosing these brain injuries can be tricky. Compared to athletes, another population that is at risk for concussions, active duty military personnel have higher baseline stress and sleep deprivation levels. Sleep disturbances and anxiety and mood swings are some of the symptoms of mild TBI.  The question for clinicians is whether these signs manifest from a brain injury or just normal wear and tear on the body.

Another challenge in diagnosing and treating military-related mild TBI is the culture. Soldiers may be more concerned with those who have more severe injuries and the culture demands that they stay and fight. The Rehabilitation and Reintegration Division is working on patient education programs to promote the idea that it is OK to sit out and be evaluated for a concussion. Promoting rest and slow return to activities is also important as that can prevent second impact syndrome.

Together with occupational therapists, the speakers created a tool kit for the military to assess and treat mild TBI. They asked themselves, what would care look like without insurance constraints and designed a comprehensive rehab package. On the one hand, it can be customized to individual service member needs, but it is also designed for the general practice PT to understand.  The military recognizes the importance of correctly diagnosing and treating mild TBI. Last year, the Army surgeon general listed implantation of concussive injury protocols as one of the top 10 initiatives for Army medicine. If the work of Drs. Weigtman and McCulloch is any indication, there will be plenty of attention paid to this quiet risk.

Each year, one of the highlights of the Combined Sections Meeting is the Pauline Cerasoli lecture. Named in honor of longtime APTA member Cerasoli, who was brutally attacked at a past CSM, and funded by her family, the lecture is given by a speaker who distinguishes him or herself as an articulate, sensitive and caring individual. This year, that honor went to Christine Baker, PT, EdD, physical therapy faculty at the University of Texas Medical Branch. In his remarks introducing Dr. Baker, the president of the APTA Scott Ward said, "Dr. Christine Baker exemplifies the qualities required for the Cerasoli lectureship.

In a talk called "Googling, Texting and Browsing, Oh My!" Dr. Baker traced the evolution of technology as a teaching tool, highlighting the benefits and the challenges presented by technology in educational environments. She had the audience laughing as she reminisced about her early years teaching. "I wrote assessments by hand; I communicated through desk phone; I showed VHS tapes in the classroom."

The challenge for today's physical therapy instructors is that their students are digital natives, never having known a world without certain kinds of technology.  Professors, like Dr. Baker, are digital immigrants, self-taught, and must learn to adapt to ever-changing technology.  Dr. Baker went through some of the contemporary ways technology can be incorporated into the physical therapy classrooms, such as distance courses, web-based interactive tutorials, blogs, audience response trackers (clickers), computerized exams, and podcasts. "There is no doubt these creative uses of technology are exciting to students."

This new technology changes the role of the physical therapy instructor. As Dr. Baker explained, "We're no longer the sage on the stage. We are the guide on the side." Today's students must be more self-motivated, have better time-management and of course, be more comfortable with all these new modes of learning, than their counterparts 20 years ago. In studies, students perceived that they learned more when they interacted in online course discussions. While chat boards are a good way to get students who would not speak up in class to share their thoughts, there's no evidence to back up that claim.

But it's obvious that technology in the PT classroom is not going anywhere. That goes for both students and professors. Today, Dr. Baker posts grades online. She screens YouTube clips in class. She monitors discussion boards while at a conference. "As we reflect on all the changes in our profession so far," noted Dr. Baker, "it's mind-boggling to think of what lies ahead."

Chicago--"We haven't been a big player, you think of OT and SLP when you think of kids with autism." So said Beth Ennis, PT, MSPT, EdD at the CSM session "Using Aquatic Therapy To Encourage Community Engagement For Families Of Children With Autism." Every seat in the room at McCormick Place was taken and some attendees even sat on the floor at this extremely popular session. Together with her Bellarmine University DPT students, Ennis is working to make sure PT has a place at the table when treating children with autism spectrum disorders.

Water is ideal with kids with ASD, some of whom also have a secondary diagnosis of sensory processing disorder. The buoyancy is supportive, the hydrostatic pressure gives constant sensory input and the resistance of the water strengthens muscles. The Bellarmine University physical therapy program wanted to create a safe environment to encourage movement.  They created a ten week aquatic therapy program for children in the community with autism.  A local facility donated the use of their pool. For ten weeks, Ennis and the students worked one on one with six children in sixty minute weekly sessions. 

They developed a program for each child based on their individual needs. Some things they did included ball toss for hand-eye coordination, core exercises on a floating mat, and jumping from student to student for strengthening. There was also a much-needed social aspect to the program as the six children were all in the pool together.

After the ten week program, Ennis evaluated the kids based on the WOTA scale, which asks questions like, How did they get into the pool? Are they comfortable? Every kid exceeded the minimal statical change with the scale. Ennis admitted that since the group was so small, more studies are needed, but she was ecstatic with the preliminary results.

Defending the PT profession can take not much more than becoming more active in your own state, as drivers of the Public Policy Practice and Professional Affairs group (PPPPA) are calling PTs and PTAs to action.

On Feb. 9 at the Combined Sections Meeting, Justin Elliott, director of state government affairs and Angela Chasteen, senior state affairs specialist for APTA, pushed members to get involved at their state level during  "PT Issues in the Statehouse: From POPTS and Infringement to Direct Access and Scope of Practice."

The main mission of PPPPA is to help advocate for state who are revising their PT practice acts, to lobby for using the title "Dr." for DPT therapists, combating POPTS conflicts, advocating for direct access, developing independent state boards of PT, and getting more PTs elected to state office.

Sounds like a tall order-but both speakers emphasized that getting involved at the state level could prove to help PTs and PTAs protect their profession at the most critical level.

"Be involved at the state level," encouraged Chasteen.  "We rely on PTs and even student members to get involved in state affairs. It's a very contentious political environment right now, and that trickles down to states and their economies. There are [fewer] dollars to spend on health care and more people demanding services. Medicaid is a growing part of all state budgets."

Health care reform law affects states directly in two specific ways, Chasteen said: in insurance exchanges and in essential health benefits (EHB) provisions. States need to set up exchanges whereby both businesses and individuals can choose policies that best suit their needs, or leave it to the federal government to set the exchanges. PT as a profession does not want to be left out of provider options, she emphasized. Also, among EHB choices, there are currently 10 categories of care that all insurance policies must cover-and PT is not specifically included, but outpatient services are.

"States are being given a little more leeway, so we're confronted with 50 different state care standards rather than one mandated standard," Chasteen said. APTA has submitted comments on the proposals to the states. The target date is March 26-28, 2012, when the U.S. Supreme Court will hear arguments on the constitutionality of the Health Care Affordability Act-including the individual mandate clause. "The question is, if the individual mandate clause is ruled unconstitutional, can the rest of the law stand?' she noted.

Also at issue is the concept of Medicaid coercion-that unless states agree to expand their share of Medicaid costs and administration, they will lose whatever funding they currently receive. At present, 26 states are challenging the constitutionality of the law, but the Court may decide they can't decide on it's lawfulness until it actually goes into effect on Jan. 1, 2014. Therefore, the PT profession needs to be prepared to confront imminent changes, she said.

Defending PT

Some of the more pervasive hurdles to the advancement of the POT profession aren't new, but Elliott reiterated where the battles for PT are the hottest.

1. Restricting PT access. This involves entities such as the American Medical Association and chiropractors trying to limit the scope of practice of PTs;
2. Emerging Encroachment from other professions. This involves entities such as exercise physiologists and others who aren't regulated but whose practice areas might overlap with PT;
3. Encroachment from regulated professions. This involves professions such as certified athletic trainers who are looking to expand their scopes of practice and who might overlap with PT;
4. State actions that might compromise the profession, such as forced consolidation of state licensing boards (where a PT state board might be forced to combine with a state OT or speech therapy board) to save revenue.

Bringing good research to realization is the key to lobby the PT profession to health care policymakers-and therapists can get involved in bringing the profession to the forefront.

Marc S. Goldstein, EdD, senior director of research for APTA, wants the organization "to be a bridge with the research realm to the policy realm," he said during part 2 of "Physical Therapists Impacting Health Policy Through Health Services Research: A Survival Strategy for Health Care Reform," held Feb. 9 at the Combined Sections Meeting.

Many PT studies never address economic issues, and APTA lobbyists need that information to make their case on the Hill, he noted. "It's all about showing the value of PT. Within the scope of the Health Care Affordability Act, we're in competition of sorts with other health care providers for health care dollars. We need to prove the value of the services we provide to compete."

APTA has organized a Public Policy Priorities group to identify PT research priorities, based on its strategic plan, Dr. Goldstein said. Included are issues teams forming to bring staff together to study professional issues APTA members need more knowledge on. "We need to be on top of changes to delivery of care before we are hit by [them]," he said. APTA has budgeted $125,000 devoted to planning for the issues groups, and encouraged attendees to find out more about them in their areas of specialty.

Calling himself a "natural pessimist," Dr. Goldstein stressed that the profession has to position itself in front of research data gathering, because it is the biggest tool in selling the value of the profession and helping APTA lobby for decision-making clout on health policy. "If we aren't proactive, we might find ourselves in the ‘valley of death'-that 17 or so year gap between when research is done and when the data is finally produced-unless we come up with new and better data. Our number one motivation is providing correct care to all of our patients, not just the economics, and that is what motivates our research. Overall, it doesn't matter how ‘elegant' or thought-out the research is, if it doesn't help us impact patient care in a more positive and economically efficient manner, with the right outcomes," he said, to attendee applause.

Delivering the Data

Getting solid data on PT research in front of the policy makers in Washington is more important than ever, said Justin Moore, PT, DPT, director of public policy and professional affairs for APTA. "Becoming consumers of health services data changes the game for us," he said. "Information and data on our research, and what we can back up with data to impact policy changes, is the new currency of public policy."

Dr. Moore said in the face of the current divisive government climate, research is even more important if the profession wants to impact changes in health policy that are coming down the pike. "It takes a lot of education of Congress on our own professional mission and goals, they want more and more information. The door was shut in our face in 2003 when MedPAC was told we didn't have the data to back up our efforts supporting direct access under the Medicare Drug Act. Policy makers want more proof in [the health care interventions] they are paying for."

The role of PT has to change as a result of upcoming health care reform, he said. "We have to prove our value-what is the best value at the most efficient cost?" He noted that the PT profession is one of the fastest-growing service providers. "We have a top rate of growth and policymakers want to know why."

With health care law changes, there will be a shift in who gets access, and the key is to show how well physical therapy services are used. "It comes down to reducing costs, improving access, and enhancing the quality of care," Dr. Moore said. "We see the next two years to 2014 as key; in effect, we have to show that health services research is a major part of our profession to end up a winner in health care reform."

What Can PTs Do?

Dr. Moore had suggestions for how APTA members and the profession at large can be a part of the efforts for health services research:

1. Talk about APTA's health services research; volunteer in your state. "We need more messengers and more advocacy on this plan," he said.
2. Propose grants to universities and groups where possible;
3. Partner with academic and patient groups, and other health care providers supporting health services research.

CHICAGO -- To quote Peter J. McMenamin, PT, MS, OCS, whether you love or hate the Health Care Affordability Act, "health services changes aren't going to go away."

McMenamin opened the session ‘Physical Therapists Impacting health Policy Through Health Services Research: A Survival Strategy for Health Care Reform, Part I" on Feb. 9 at the APTA Combined Sections Meeting.

Therapists need to recognize the importance of participating in health services research. The debate over changing health care policy is decided; now, the PT profession has to prove their worth in health services reimbursement and decisions on care delivery.

"PT has always been involved in health care research; we sent reconstruction aides to Europe, where Britain used rehab services to improve outcomes for soldiers, and this evolved into the PT profession," he said.

The questions for the profession are, can PT be more efficient, effective and equitable? "We can't be wasting time with less effective treatments," he said. The profession will be undertaking more systemic reviews and random controlled trials in research. Efficiency in practice is just as important. McMenamin noted that the U.S. spends $8,000 per person for health care, but still ranks 65^th out of 100, with 48 million still uninsured. "Ask, do we get enough bang for our buck for $8,000?" he said

Research involves economics, there is no escaping it," he said. "It becomes a consumer issue: Can people afford care? And can businesses afford premiums? And of course it is becoming a huge political issue as well," McMenamin said.

The moment has arrived for the PT profession to act, or be pushed to the margins of health policy decisions on how consumers can both select and pay for quality health care. "Our role is to make our services more accessible to consumers," he said.

PTs in Health Services Research

Janet Freburger, PT, PhD, who is a researcher with the Cecil G. Sheps Center for Health Services Research, said within the last decade, the PT profession has grown in providing broader research for journals, which increases the visibility of the PT to address many problems facing the health care system in the U.S.

She noted that a lack of evidence on treatment can lead to overuse, underuse and misuse of care. "We have to provide services based on scientific knowledge and avoid those services not likely to benefit the patient," she said. There is a lot of practice variation within the scope of PT treatments, often because there is a lack of evidence to support many treatments, as well as a lag between discovery and implementation of new treatments that could be effective.

Sometimes higher spending [on treatments] doesn't relate to better outcomes, and that is why the profession needs to be at the forefront of health services research, to concentrate on the treatments that are both effective and efficient and have the data to back them up.

She said PT seems to take the lead in equitable care. In outpatient care provision, there are some disparities in areas of research, but overall there is little evidence of racial or ethnic disparity for PT, "which shows we aim to understand different populations" in providing care.

She discussed studies of efficiency in PT care delivery, and noted that the profession has proved that earlier PT care does benefit most patients overall, and that other studies have shown that direct access for PT does lead to better outcomes, as well as being more efficient in some cases, relieving physicians from duties prescribing PT. Both research-based arguments benefit the PT profession.

"We need to understand what works best, and have to get patients more involved in choosing their own care," she said. Opportunities for more research are built into the Affordable Care Act, she noted, and the focus is on comparative clinical research. "We need more studies to help decrease any disparities in care delivery," Dr. Freburger noted.

The health policy subject was a popular one at the conference; look for follow-ups on this blog for Part 2 on the initiatives APTA is taking to improve its position in health policy decision-making.